Provider Demographics
NPI:1477751857
Name:COOKSTON, MICHAEL DEAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:COOKSTON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ASH ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-3127
Mailing Address - Country:US
Mailing Address - Phone:307-761-1169
Mailing Address - Fax:
Practice Address - Street 1:205 BOYD AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2965
Practice Address - Country:US
Practice Address - Phone:307-746-2741
Practice Address - Fax:307-746-9405
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5551183500000X
WY3171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist